Report Dec 12 06 11:16a Darkhorse Construction 5037235151 p.3
L ealc\ O Se- COPY
WASHINGTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH AND SANITATION
AUTHORIZATION NOTICE REPORT iti\S
CR ft.: 971038 197(34 X)atc(s) of inspection: i z(Stocc,
Date Rcc'd: It! 3o/ c% C OPY
f ILE - 17P AUTIIORIZA PION NOTICE REPO
( MEMORANDUM
Map and Tax lot number: Township 25 Range 1 Section 1 2039 T.L. #. l Goo
Road Name: 15030 5■,k! Ice A.464L3s3 TtC -./trzD
Property Owner: T'EF� ChMP�3�1 - 4-
t5C3o Sw ° 71 Mers'E
TIC-i1 4 v2 ‘ ) 1 7 . 2 -
APPROVED
This notice authorizes the use of the on -site sewage disposal system located on the property identified
above to serve a
with a sewage flow up to 4,0 gallons per day.
DENIM.[)
If Authorization Notice is denied, it may be reviewed by the Department of Environmental Quality
upon request. An application must be submitted for review within 30 days. A denial review fcc is
charged.
COMMENT'S /CONDITIONS: F7/.517/l a rf'7U 547604 / Ot$/l /' t (e i 5 � - ' ap"`
/ `D ,.vl E , 7F1 ` /A/cez yr 56 771E 1 /U.44602 a CLFrilz 5 7;D ,GY )2 (4).
• W/ 5 /5 " /,vicerat56 b= 7 7tg //1v.t i 7 J afrh `l F-ovi c. Y 95' 4,e ( 1 7 4 . 6 R'
. • 0 CP . 71 .$505 th-7 C eevi 5 i (2e5/d//( Y ip Nom.
�vto/k� r /iy/tr4 . 77 SCPI1 G 5-45M AA V W 3 r‘le ttt 5 (0 3 icu. -t5
ar /144 tC ere. F�trc.�2� ifl T/ivc 01/446PeCn /,. 71 ,5 syszc
S //Du L p F tiL Ac- / 1 Fty" -7/115 c is e /3 r Z0 !25th P/2/• 71 5 '5•7L�v"�-
SANITARIAN: �g DATE: I Z1N0(o
F:\Authorizatioo Notice Re. .rt.d• . ••/10/2004